Pectus Excavatum

The Pediatric Surgery team at American Family Children's Hospital in Madison, Wisconsin, treat children with pectus excavatum, also known as sunken chest or funnel chest.

What is pectus excavatum?

Pectus excavatum is the most common congenital abnormality of the chest in children. It can present as a mild depression of the sternum (breastbone) to a very deep depression, where the sternum nearly touches the spine. Abnormal growth of the rib cartilage causes the breastbone to be pushed inward. This depression in the breastbone may be symmetrical (even), or it may be more inward on one side than the other. The breastbone may be straight or rotated.

Some children are known to have pectus excavatum since they were babies. In others, it does not become noticeable until a large growth spurt, usually during puberty.

The cause of pectus excavatum is unknown. There is a familial tendency, with 25 percent of patients reporting a family history of chest wall abnormality.

What are the symptoms of pectus excavatum?

The most common symptom associated with pectus excavatum is shortness of breath or decreased endurance with exercise. Some people will also have asthma-like symptoms and may be treated with different asthma medications, often without any relief. Other children have chest pain, usually at the area of the abnormal rib cartilage. Many children and their parents report that the child feels embarrassed about the appearance of their chest.

Exercise generally will make the shortness of breath or chest pain worse.

How is pectus excavatum fixed?

Non-surgical remedies: Not all patients with pectus excavatum require surgery. Some mild forms can be improved with upper-body strengthening exercises and improvement in posture.

Surgical remedies: Patients with a moderate to severe chest depression or significant symptoms may require a minimally-invasive operation during which surgeons make a small incision on each side of the chest, and another incision beneath the breastbone. A stainless steel bar that is curved to fit around the front of the chest is placed under the breastbone from one of the side incisions and passed to the other side. The incision beneath the breastbone is used to guide the bar under the breastbone. The bar is then rotated, which pushes the breastbone out into a more normal shape. The procedure generally takes about one and one-half hours. The bar is left in place for for two to three years to allow the chest to re-shape. After the chest has remodeled, the bar will be removed in a same-day surgery procedure.